Facility Evaluation Report
Capacity6
Census4
Date signed07/02/2026 01:56:11 PM
Name of licensing program analystStar Stevenson
Name of licensing program managerBethany Moellers
At approximately 1:20 PM Licensing Program Analyst (LPA) Star Stevenson arrived unannounced for the purpose of getting a facility signature on an amended LIC809 Report created on 06/30/2026.
LPA met with caregiver Keyshawn Melton who has Designation of Facility Responsibility (RP). A call was received from Licensee Anny Camerino and the purpose of today's Case Management visit and reason for Amendment of the 06/30/2026 LIC809 Document was explained.
Report was review with RP, whose signature here denotes receipt.
Source: California Department of Social Services, Community Care Licensing. Methodology · Report a correction